Tran Phuong T, Riaz Munaza, Chen Ziyan, Truong Cong Bang, Diaby Vakaramoko
Faculty of Pharmacy, HUTECH University, 475A Dien Bien Phu Street, Ward 25, Binh Thanh District, Ho Chi Minh City, 700000, Vietnam.
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
Clin Drug Investig. 2022 May;42(5):377-390. doi: 10.1007/s40261-022-01155-5. Epub 2022 Apr 30.
Although many systematic reviews for the human papillomavirus vaccines cost effectiveness have been published, they vary in perspectives, methods, and quality. We aimed to condense systematically such evidence to facilitate locating, processing, and learning, not only about the consensus of findings but also how models were built and their evolution over time and across settings.
We conducted an umbrella review of cost-effectiveness studies for human papillomavirus vaccines using three databases (PubMed, Embase, and Cochrane). Based on their objectives, we classified studies into three groups (human papillomavirus vaccines cost effectiveness, model characteristics, and all-type vaccines, including human papillomavirus vaccines). We used the AMTAR2 to assess the quality of the studies. Additionally, we provided a summary of study findings, discussions, and evidence gaps in the literature.
Though most studies were critically low quality and had a low quality of reporting, the human papillomavirus vaccine was consistently cost effective in young girls and men who have sex with men. Stratified analyses by rated quality did not change the results. The quality assessment of the reviews did not necessarily reflect the quality assessment of underlying studies. The human papillomavirus vaccine models became more complex over time, capturing more realistic disease transmission with different human papillomavirus strains and herd immunities.
Additional evidence is needed for vulnerable populations (e.g., childhood cancer survivors) who are at high risk for human papillomavirus vaccine-related cancers and, therefore, may be more cost effective when receiving human papillomavirus vaccines. Quantifying human papillomavirus vaccine cost effectiveness via meta-analyses is feasible if investigators can increase the homogeneity of their populations.
尽管已经发表了许多关于人乳头瘤病毒疫苗成本效益的系统评价，但它们在观点、方法和质量上存在差异。我们旨在系统地汇总此类证据，以方便查找、处理和学习，不仅了解研究结果的共识，还包括模型是如何构建的以及它们随时间和不同环境的演变。
我们使用三个数据库（PubMed、Embase和Cochrane）对人乳头瘤病毒疫苗的成本效益研究进行了一项综合性综述。根据研究目的，我们将研究分为三组（人乳头瘤病毒疫苗成本效益、模型特征以及包括人乳头瘤病毒疫苗在内的所有类型疫苗）。我们使用AMTAR2评估研究质量。此外，我们还总结了文献中的研究结果、讨论内容和证据空白。
尽管大多数研究质量极低且报告质量较差，但人乳头瘤病毒疫苗在年轻女孩和男男性行为者中始终具有成本效益。按质量评级进行的分层分析并未改变结果。综述的质量评估不一定反映基础研究的质量评估。随着时间的推移，人乳头瘤病毒疫苗模型变得更加复杂，能够更真实地反映不同人乳头瘤病毒毒株和群体免疫的疾病传播情况。
对于人乳头瘤病毒疫苗相关癌症高危的弱势群体（如儿童癌症幸存者），还需要更多证据，因此，他们接种人乳头瘤病毒疫苗时可能更具成本效益。如果研究人员能够提高研究人群的同质性，通过荟萃分析量化人乳头瘤病毒疫苗的成本效益是可行的。
